Over half of callers can’t get coverage - journalpatriot: News
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Over half of callers can’t get coverage

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Posted: Monday, April 14, 2014 1:59 pm

Over half of the 898 people who contacted a temporary counselor in Wilkes County for help in signing up for health insurance during the first federal Affordable Care Act (ACA) open enrollment period didn’t qualify.

Most of these 512 people unable to get insurance with reduced premiums through the ACA didn’t qualify because their incomes were below the federal poverty level, said Wilkes Health Department Director Ann Absher. Minimum annual income for a single person to qualify is $11,490. It’s $23,550 for a family of four.

Because North Carolina’s legislature and governor opted out of the Medicaid expansion allowed under the ACA, the state’s uninsured people with incomes at the federal poverty level and below aren’t eligible for Medicaid (unless they’re disabled or in certain other cases) for reduced cost insurance under the ACA. The federal government was to pay all Medicaid expansion costs in its first three years and at least 90 percent after that.

The first open enrollment period was supposed to end March 31 but was extended to April 15 (Tuesday), partly to allow extra time for people unable to navigate through the ACA website.

Mrs. Absher said 12 percent of the 898 people who called counselors since early March were only seeking information, so officials don’t know how many of them got insurance by going to the ACA website or through an insurance agent.

In many cases, the counselors made referrals to insurance agents. The number of Wilkes people who signed up on their own or with insurance agents isn’t known.

Four percent of the people who called a counselor and apparently qualified cancelled their appointments with counselors..

Shellie Bowlin, among four counselors hired by the Wilkes Health Department to assist people interested in signing up in the first enrollment period, said the many working Wilkes Countains seeking but unable to get affordable insurance through the ACA and ineligible for Medicaid due to incomes at or below the federal poverty level was disheartening.

“There was a high number of people working, sometimes with three jobs, who still didn’t have a high enough income to qualify and didn’t know what to do,” said Mrs. Bowlin.

She estimated that over half of the adults in Wilkes County can’t afford and so don‘t have private insurance and also don’t qualify for Medicaid because eligibility wasn’t expanded in North Carolina.

Local officials earlier estimated that at least 3,000 to 4,000 of an estimated 12,000 uninsured Wilkes Countians would have been eligible for Medicaid if state officials had approved the expansion.

Some didn’t qualify for insurance under the ACA when their children were added because income requirements increase with more dependants. Mrs. Bowlin said many of adults in this situation ended up getting Medicaid coverage for their children.

About 24 percent (212) of the people who called one of the counselors qualified for health insurance under the ACA. By qualifying, their insurance premiums will be reduced by varying amounts with tax credits.

Mrs. Bowlin said some of these 212 people were previously unable to get insurance due to pre-existing health conditions. The ACA prohibits insurance companies from denying coverage due to pre-existing health conditions.

She said some who qualified were young people just now old enough to buy their own insurance and some were elderly people. Others were older people needing private insurance until they become old enough to quality for Medicare in a year or two.

Mrs. Bowlin said some people who qualified decided not to get insurance under the ACA because they smoke and so faced paying premiums three times the cost for non-smokers.

She said several people with affordable insurance through their employers were disappointed to learn that they couldn’t get it for immediate family members through the ACA.

The four counselors were hired and trained through grants of up to $66,000 from the Health Foundation in North Wilkesboro and $1,500 from the Northwest Area Health Education Center and started receiving calls and seeing people in person in early March.

Mrs. Absher said the health department plans to employ counselors again, but not as many, during the next open enrollment period, which is Nov. 15, 2014, to Feb. 15, 2015.

The counselors were stationed at the Wilkes Health Department, Wilkes Physician Network at West Park, Health Foundation at West Park, North Wilkesboro and Wilkes Department of Social Services (DSS) and were available by calling 838-0047.

Blue Cross/Blue Shield and Coventry are the only two insurance companies that elected to participate in the “Marketplace,” the name for insurance options available through the ACA, in North Carolina. Only Blue Cross/Blue Shield policies are available through the ACA in Wilkes and most other rural areas of the state.

Some people with insurance costs lower than under the ACA are choosing to be “grandfathered” and keep their current plans.

The Wilkes Department of Social Services is playing a role in the ACA initiative by evaluating uninsured people to determine if they meet income requirements for insurance through the ACA or for Medicaid.

People between 250 and 400 percent of the federal poverty level don’t get cost sharing so their deductibles are higher. The counselors haven’t seen many people above 250 percent. The maximum deductible is $6,300, which is still lower than the deductibles a lot of people formerly had.

Under the ACA, people can go three consecutive months each year without health insurance. After that, they’re penalized $95 or 1 percent of adjusted gross income for an adult and $47.50 for a child per year. Penalties increase each year a person is without insurance.

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